PROJECT SUMMARY/ABSTRACT Chronic Obstructive Pulmonary Disease (COPD) is caused primarily by smoking and smoking cessation is the first-line treatment for slowing disease progression. Despite this, nearly 50% of COPD patients continue to smoke following diagnosis. Smokers with COPD report high rates of co-occurring conditions ? nicotine dependence, depression, and anxiety ? which serve as barriers to quitting. The proposed research will develop and pilot test a behavioral intervention designed to target the common psychological factors underlying these co-occurring conditions and foster smoking cessation among COPD patients. Primary aims of the proposed research are to: 1) Refine behavioral treatment components through qualitative interviews with patients and providers, 2) Develop a tailored behavioral treatment to address psychological risk factors among COPD patients using single case design experiments, and 3) Conduct a pilot randomized controlled trial (RCT) to examine the effects of the multi-component intervention on smoking outcome, as compared to minimally-enhanced usual care. The proposed project will be the first to adapt a behavioral treatment to specifically target psychological risk factors among COPD patients who smoke. By addressing core psychological risk factors, the behavioral treatment may help buffer against stress associated with disease progression and increase COPD patients' exercise tolerance, engagement in pulmonary rehabilitation, and quality of life. Thus, this intervention has potential to obviate a large number of health burdens among COPD patients, and ultimately to reduce morbidity and mortality associated with COPD. Amanda Mathew, PhD, a Research Assistant Professor at Northwestern University Feinberg School of Medicine, is seeking five years of support through the K23 Mentored Patient-Oriented Research Career Development Award for training and research related to development and testing of smoking cessation interventions targeted to psychological risk factors among COPD patients. Dr. Mathew's overarching career goals are to elucidate the mechanisms by which psychological factors impact cigarette smoking, develop novel interventions for smokers with medical and psychiatric comorbidities, and reduce tobacco-related health disparities. Through the proposed training plan, Dr. Mathew will expand her knowledge and skills related to intervention development; behavioral RCT design, conduct, and analysis; and smoking cessation and treatment needs specific to individuals with COPD. Dr. Mathew's multidisciplinary mentorship team has demonstrated expertise in these content areas, and is committed to Dr. Mathew's career development. Dr. Mathew's proposed work is also well-aligned with behavioral medicine research priorities within the Department of Preventive Medicine at Northwestern University Feinberg School of Medicine.